Surgical management of epilepsy

The chapter describes procedures for surgical management of drug-resistant epilepsy. The presurgical evaluation is outlined including the use of MRI, and functional imaging with PET and single photon emission computed tomography (SPECT). The importance of electroencephalographic recordings of seizures in split-screen video technique is underlined. The spectrum of interventions includes temporal lobe procedures (selective amygdalohippocampectomy, two-thirds temporal lobectomy, and tailored lateral resections), in addition to extratemporal lobe resections consisting of lesionectomies, extended lesionectomies, but also lobectomies and multilobectomies. Hemispherectomies/hemispherotomies of various types are described and a second disconnective procedure: callosotomy. Vagal nerve stimulator implantation as a palliative procedure is detailed, and other operations are briefly touched (such as hypothalamic hamartoma disconnection, deep brain stimulation, and responsive cortical stimulator implantation). The chapter is concluded by briefly discussing outcome of epilepsy surgery and management of complications. The controversy concerning small temporal lobe resections versus classic lobe resections is outlined.